Acute Appendicitis: A prospective study comparing clinical appendicitis with histopathological appendicitis.

Abstract

Objective: To compare clinical appendicitis with histopathological appendicitis. Study Design: Prospective Cross-sectional study. Setting: Department of Surgery, Lady Reading Hospital, MTI, Peshawar. Period: December 2019 to March 2020. Material & Methods: Out 106 patients with signs and symptoms of acute appendicitis 100 patients were included in the study. 6 patients were excluded because of incomplete data. Patients were examined, ALVARADO score was calculated and routine investigations were done. After open appendectomies all specimens were sent for histopathology. Results: Male to female ratio was 1.7:1, with a mean age of 25 ± 11 year. The most common presenting complain was right iliac fossa pain (98%), followed by nausea/vomiting (86%). The commonest signs elicited were right iliac fossa tenderness (100%), rebound tenderness (100%). Mean ALAVARADO score is 7.39 ± 1.03. Intraoperative findings showed acutely inflamed appendix (90%), perforated appendix (7%) and normal (1%). The histopathology specimens showed acute appendicitis (88%), acute appendicitis with periappendicitis (8%) and normal histology (1%). Conclusion: Our study comparing clinical appendicitis with histological appendicitis with a negative appendectomy rate of only 1% suggests that acute appendicitis remains a clinical diagnosis and that timely accurate clinical diagnosis can prevent many complications associated with delayed/misdiagnosis of acute appendicitis. Laboratory evaluation and imaging especially CT may help in establishing diagnosis in equivocal cases but often leads to delay in diagnosis and also puts extra burden on the health care system.